Provider Demographics
NPI:1093476970
Name:EMERY, THERESA (LICSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:EMERY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12611 PROWELL ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-9015
Mailing Address - Country:US
Mailing Address - Phone:802-881-9493
Mailing Address - Fax:
Practice Address - Street 1:12611 PROWELL ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-9015
Practice Address - Country:US
Practice Address - Phone:802-881-9493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker